Effect of music on ambulatory surgery patients' preoperative anxiety

AORN Journal, April, 1996 by Penny Augustin, Anthony A. Hains

Increasing numbers of surgical procedures are being performed in ambulatory surgery centers (ASCs) due to new technology and the demand for cost-effectiveness. In 1986, approximately eight million surgical procedures were performed in hospital-based ASCs, and, by 1992, this number had increased to more than 12 million procedures. Ambulatory surgical procedures are expected to exceed the 14 million mark this year.(1)

Patients undergoing surgical procedures often experience anxiety in anticipation of events that will be unfamiliar or uncomfortable or possibly lead to undesirable results. Even minor surgical procedures can produce anxiety in patients and affect their postoperative recoveries and risks for physiological complications.(2) Reduction of patients, pre-operative anxiety can decrease their postoperative pain, vomiting, surgical complications, and recovery times.(3)

LITERATURE REVIEW

Most research on reducing preoperative anxiety has focused on preoperative patient teaching. A meta-analysis of 68 studies supported the belief that preoperative patient instruction produces beneficial effects by reducing anxiety and promoting favorable surgical outcomes. In these studies, preoperative instruction affected physical variables keg, length of hospitalizations, fever, analgesic needs, sedative requirements and psychological variables, which were measured from various self-report inventories. The researchers documented that identifying patients, individual needs was an important factor in the effectiveness of preoperative patient teaching.(4)

New interventions specific to reducing ambulatory surgery patients, anxiety are needed. An extensive 1989 review of preoperative psychoeducational interventions indicated that preoperative instruction programs should include both procedural and sensory/psychological content and that interventions should be geared toward different categories of patients.(5) At least one researcher has documented the need for individualizing teaching approaches and seeking new methods to reduce preoperative ambulatory surgery patients' anxiety.(6) One adjunct to preoperative teaching that may reduce patients, anxiety is encouraging them to listen to relaxing music through headphones. This safe, noninvasive intervention may help patients achieve psychological and physical relaxation, which is a response in direct opposition to anxiety.

Since ancient times, clinicians have recognized that quiet, nonvocal music decreases physiological responses associated with stress.(7) Researchers have documented that music reduces anxiety in a variety of health care settings and patients (eg, adults undergoing chemotherapy, hospitalized infants add toddlers, women in labor).(8)

Few researchers, however, have examined the effectiveness of music as a preoperative relaxation agent. In one study, sedative music effectively reduced anxiety in 33 patients waiting in a preoperative holding area to undergo arthroscopic surgical procedures.(9) Another study used television viewing as the anxiety-reducing intervention for preoperative patients and documented a significant decrease in anxiety among patients who watched television compared with those who did not.(10)

A few investigators have examined the effects of music on patients, anxiety during surgical procedures. In one study, the hypothesis that sedative music heard through headphones would reduce anxiety of patients undergoing arthroscopic surgical procedures was not supported. The sample size in this study was small, the patients received general anesthesia, and the patients, music preferences were not considered. The investigator noted that anxiety was difficult to measure because the patients had varying levels of consciousness and the medications they received affected their vital signs.(11) In another study, a certified registered nurse anesthetist was able to reduce patients' perioperative anxiety by having them listen to music through headphones as an alternative or adjunct to pharmacological sedation measures.(12) Another group of researchers documented that music used during laceration repairs provided a safe, inexpensive, effective adjunct to pain management but did not significantly affect patients' anxiety.(13)

Patients' familiarity with the music selections may be important for producing optimal relaxation. In one study, the investigator interviewed patients about experiences of listening to music during elective surgical procedures for which they received local or regional anesthesia. These patients verbalized the importance of personally choosing their music selections, and 50% of them stated they would have brought their own music selections to the hospital if someone had suggested this intervention.(14) Another investigator analyzed the use of music for stress reduction and reported that slow, arrhythmic music, which otherwise meets all criteria of sedative music, may appear foreign or frightening to some listeners. This investigator suggested that patients, music preference may be an influential factor worthy of investigation.(15)